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Skin Cancer Screening

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

Skin cancer is one of the most common types of cancer, affecting around 300,000 people worldwide [1]. Our skin is the largest organ in our body, and plays an important role in protecting us from external harm such as pathogens, ultraviolet light, and environmental stressors. This makes the skin vulnerable to conditions such as skin cancer.

Early detection of skin cancer is important to keep our skin healthy and functioning properly. Identification and detection of potentially cancerous skin lesions is commonly done through a skin cancer screening.

What is skin cancer screening?

A screening is done to look for diseases before symptoms start to appear. This gives doctors a chance to detect the diseases at an early stage and treat it before it starts to spread or worsen. Treating cancer at its early stage is also much easier, and gives a better chance of survival for the patient [2].

Skin cancer screening is important in detecting potentially malignant skin growths or lesions that may eventually develop into cancer.

When should I go for skin cancer screening?

Abnormal changes in the skin, such as new growth or changes in a mole, are the most common signs of a potential skin malignancy. A common guideline to follow if you are concerned your mole may be cancerous is the ABCDE guideline.

Asymmetrical – The shape of your mole may be uneven or irregular
Border – The borders of your mole are jagged, scalloped, or blurred
Colour – The mole may have multiple colours or multiple shades of brown, black, red, or white
Diameter – The diameter is larger than 6mm, roughly the size of a pencil eraser
Evolution – The mole or spot changed or evolved in the past few weeks, such as becoming larger, changing shapes or colour, or becoming elevated

Moles with these characteristics are not always cancerous, but may have potential to become cancerous. If you are concerned with your moles or spots becoming cancerous, a skin cancer screening is the right test for you.

I think I have skin cancer — what to do next?

If you are concerned about lesions, moles, or unexplained growths on your skin that may be cancerous. The ideal course of action is to undergo a skin assessment by a dermatologist. However, changes in moles or spots on your skin may not be apparent, especially if you are used to seeing it everyday and these changes happen over time. If you suspect that a mole, or spot may be cancerous you can:

Take photos of the suspected lesion – Preferably with a ruler or something to indicate the size and shape of the lesion. Unlike moles, skin cancer growths are more likely to change in shape, colour, or size.
Show the pictures to your doctor during check-ups or screenings – Skin cancer lesions can vary in their progression, documenting changes of your lesions allows the dermatologist to identify whether the lesion is cancerous based on how fast the lesion changes or evolves.
Be consistent with your pictures – Try to take the picture from the same angle, under the same light/time of day, with the same tool for size comparison. Keeping these variables constant can help your dermatologist observe and compare the changes more accurately.
Check for signs of irritation or inflammation – Normally moles or benign growths do not cause signs of inflammation such as pain, itching, bleeding or swelling. If you notice any of these with changes of your moles, you may need to get it checked by a dermatologist immediately.

In any case, the only way to know if a lesion is cancerous is by getting a dermatologist to check and diagnose the lesion. Skin cancers like melanoma can be treated and managed if detected early. However, it can also be life-threatening if not detected and treated early, as it can spread to other parts of the body. It is always better to be safe than sorry, hence, always seek medical attention in case of doubt or concern, don’t wait until it is too late!

Skin Cancer vs Mole vs Scar

How can you tell if a growth is cancerous? Some skin cancer lesions may resemble moles or scars, although you will still require a doctor’s assessment, several differences of skin cancer, moles, or scars include:

Feature	Skin Cancer	Mole	Scar
Colour	Can be mixed or unevenly coloured, such as red, white, brown, black, grey, or blue.	Usually only in one colour which can be black, brown, or shades that are similar to the person’s skin tone.	Scars can be lighter or darker than your skin tone, they typically are a single colour.
Shape	Irregular, asymmetrical shape, can have irregular or jagged borders	Usually even or symmetrically shaped	Scars often take up the shape of the wound that caused it
Size	Larger than 6mm in diameter, can grow or become larger	Usually smaller than 6mm diameter, size also hardly changes over time	Size depends on the wound that caused it
Texture	Can have scaly, lumpy, or pearly appearance	Usually has a smooth or flat surface	Scars can be raised (hypertrophic/keloid) or depressed (atrophic), common examples are acne scars
Growth/Changes	Changes or evolutions are characteristic of potentially cancerous lesions.	Moles typically do not change much over time	Hypertrophic and atrophic scars remain the same size, and may improve in appearance over time. Keloids may grow beyond the wound border
Sensation	Skin cancer lesions may ooze, crust, bleed, or feel painful or itchy	No remarkable sensation	Some scars can feel itchy, especially during healing

Other common signs of skin cancer to look out for include:

A new mole, or and old mole suddenly changing
A pearly, shiny, or bump
Unexplained flesh-coloured or brown scar-like lesion
Wounds or scabs that never heals or returns
Rough, scaly lesions
Sores that look crusty, depressed, or bleeds often
Red nodules on the skin

If you have these symptoms or notice sudden changes in the spots or moles on your body, a dermatologist’s assessment is important for proper diagnosis in order to get it treated.

Common types of skin cancer detected in screening

Skin cancers are commonly divided into melanoma and non-melanoma skin cancers.

Melanoma – Skin cancer of the melanocytes, the cells that produce melanin, and are located in the basal layer of the epidermis [3].
Non-melanoma skin cancer – Skin cancer which are not derived from melanocytes, these include:
— Basal cell carcinoma (BCC) – skin cancer derived from the basal cells, these cells reside at the bottom layer of the epidermis.
— Squamous cell carcinoma (SCC) – skin cancer of the epidermal keratinocytes, located at the top layer of the epidermis [3].

Skin cancers should not be underestimated, cancer of the deeper layers such as melanoma can spread to other parts of the body via the lymph nodes. As with other types of cancer, early detection is the biggest factor in improving survivability. Survival rates of melanoma patients decline with advancement of the disease [4]. This is why it is extremely important to get unexplained lesions assessed by your doctor.

What other skin conditions can skin cancer screening detect?

Other than detecting potential skin cancer lesions, frequent skin screening can help your dermatologist identify other skin conditions. These may include chronic skin conditions that may require treatment.

Atypical moles (Dysplastic nevi) – Dysplastic nevi are irregular moles that look different from common moles, these are typically harmless, but may increase the risk of melanoma.
Psoriasis or Eczema – During a skin cancer screening, the dermatologist may also diagnose other chronic skin conditions such as psoriasis and eczema.
Skin infections – Skin infections can be detected and hence diagnosed during a screening.
Rashes – The dermatologist may also examine rashes which may be caused by contact dermatitis, psoriasis, eczema, or infections.
Lipomas or cysts – Lipomas are benign growths of fat under the skin, while cysts are bumps under the skin containing pus or fluid. These can be then treated by the dermatologists.
Seborrheic keratosis – Seborrheic keratosis are benign growths on the skin, they are usually harmless and do not require removal.
Precancerous lesions – Lesions that have risks to develop into cancer, such as actinic keratosis, can be identified and treated early with regular screening.

What are the risk factors of skin cancer?

Anyone can be at risk of developing skin cancer. However, doctors and scientist have identified the following as common risk factors of skin cancer [3, 5]:

Ultraviolet radiation (UVR) – UVR from sun exposure, tanning beds, and sunburns are among the most common risk factors of skin cancer.
Pale skin – Pale skin, or skin that sunburns easily is among the non-modifiable risk factors. Patients with pale skin may lack the pigment melanin, which protects the skin from UVR [3]. However, this does not mean dark skinned patients are free from risks of skin cancer.
Moles – The presence of moles, especially having lots of them, presents a potential risk of the moles developing into a cancerous growth.
Family or personal history of melanoma or cancers – Genetic risks are non-modifiable risk factors. Furthermore, cancer survivors are also at risk for skin cancers due to radiotherapy, genetic factors, immune suppression, and organ or stem cell transplantation [5].
Weakened immune system (i.e. HIV/AIDS, organ transplants) – Having a weakened immune system from infections, medications, or medical treatment such as organ transplants are at a higher risk for developing skin cancer such as basal cell carcinoma and squamous cell carcinoma.
Old age – Older people are more likely to develop skin cancer likely due to cumulative sun exposure over the years.
Exposure to carcinogens – Exposure to harmful carcinogens such as by smoking also increases the risk of skin cancer.

Skin cancer risks can be modifiable or non-modifiable. Reducing the risk of skin cancers by adjusting the modifiable risk factors can be as simple as wearing sun protection and limiting time outdoors. Frequent skin cancer screening can further mitigate the risks of skin cancer developing.

What can I expect from a skin cancer screening?

The general process of a skin cancer screening is as follows:

Consultation — Before the examination, a consultation session is necessary for our dermatologists to assess your skin condition, medical history, and clarify any specific skin concerns you have.
Examination — The skin cancer screening is conducted by performing a full-body examination, assessment of any skin lesions, moles, or abnormal growth. In some cases, your dermatologist may conduct dermatoscopy, by using a microscope to closely examine the lesions or moles for structures that may not be visible to the naked eye.
Recommendations — After the screening, your dermatologist will give you recommendations based on the findings. This may include close monitoring of your skin or further evaluation or diagnostic tests such as a skin biopsy. Other times, if your dermatologist detects other skin conditions you may have, they may recommend treatment for the condition.

If you are concerned with any skin growths or suspect a mole may be precancerous, a consultation to a dermatologist can be helpful in identifying and managing your concerns. Many underestimate it, but an early detection in skin cancer can be life-saving. Schedule a consultation with our dermatologists now for a comprehensive screening and diagnosis.

Frequently Asked Questions

Can skin cancer be cured if detected early?

Skin cancers are highly curable if detected early [4]. In fact, early detection is the key to survival in most cases of skin cancer.

How often should you get screened?

It is recommended to get a skin cancer screen every year once you hit your 20s or 30s, it can be more frequent if you are at a higher risk, i.e. spending long hours outdoors, having many moles, having pale skin or skin that sunburns easily.

Is skin cancer life-threatening?

If not treated early, skin cancer cells have the potential to spread to other parts of the body and cause other malignancies such as in the lungs, breast, prostate, and pancreas [5, 6]. This often occurs from the metastasis of melanomas via the lymphatic system. This way the cancer can become aggressive and life-threatening.

How can I reduce the risk of getting skin cancer?

Common practical habits to reduce the risk of skin cancer are wearing sunscreen and/or protective clothing, limiting sun exposure, and getting skin cancer screenings regularly for high-risk individuals.

Can skin cancer spread?

If not treated, skin cancers such as melanomas can spread to other parts of the body.

Are all moles cancerous?

Not all moles are cancerous, but it can potentially turn cancerous. This is why people with lots of moles are at a higher risk of developing skin cancer.

References

Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. doi: 10.3322/caac.21834. Epub 2024 Apr 4. PMID: 38572751.
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan;72(1):7-33. doi: 10.3322/caac.21708. Epub 2022 Jan 12. PMID: 35020204.
Gordon R. Skin cancer: an overview of epidemiology and risk factors. Semin Oncol Nurs. 2013 Aug;29(3):160-9. doi: 10.1016/j.soncn.2013.06.002. PMID: 23958214.
Hartman RI, Lin JY. Cutaneous Melanoma-A Review in Detection, Staging, and Management. Hematol Oncol Clin North Am. 2019 Feb;33(1):25-38. doi: 10.1016/j.hoc.2018.09.005. PMID: 30497675.
Watson M, Holman DM, Maguire-Eisen M. Ultraviolet Radiation Exposure and Its Impact on Skin Cancer Risk. Semin Oncol Nurs. 2016 Aug;32(3):241-54. doi: 10.1016/j.soncn.2016.05.005. Epub 2016 Jul 29. PMID: 27539279; PMCID: PMC5036351.
Maitra SK, Gallo H, Rowland-Payne C, Robinson D, Møller H. Second primary cancers in patients with squamous cell carcinoma of the skin. Br J Cancer. 2005 Feb 14;92(3):570-1. doi: 10.1038/sj.bjc.6602306. PMID: 15611792; PMCID: PMC2362093.
Bradford PT, Freedman DM, Goldstein AM, Tucker MA. Increased risk of second primary cancers after a diagnosis of melanoma. Arch Dermatol. 2010 Mar;146(3):265-72. doi: 10.1001/archdermatol.2010.2. PMID: 20231496; PMCID: PMC3076705.

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